This document provides an overview of pancreatitis, including: - It describes acute and chronic pancreatitis, with acute pancreatitis presenting with abdominal pain and elevated enzymes. - The mechanism involves premature enzyme activation leading to autodigestion and inflammation of the pancreas. - Signs, symptoms, and imaging findings are discussed for assessing severity and managing acute pancreatitis. Complications like fluid collections, necrosis, and abscesses are also covered. - Treatment involves conservative management for mild cases and intensive care, monitoring, antibiotics and drainage procedures for more severe cases.

1. Pancreatitis
YUVARAJ KARTHICK

2. Introduction
 Inflammation of the parenchyma
 Divided into A/c & C/c.
 A/c presents with acute abdominal pain with elevated
enzyme levels
 Underlying mechanism???
 A/c pancreatitis subdivided into Mild and Severe

3.  Chronic pancreatitis:
 Continuing inflammatory disease characterized by irreversible
morphological change  permanent loss of function.

4. Mechanism:
  inciting agent Premature activation of enzymes 
Autodigestion  Inflammation sets in  Pancreatic edema 
hemorrhage and eventually necrosis
 Inflammatory mediators into the blood stream  Systemic
complication

5. Acute
Pancreatitis
 Accounts for 3% of cases
of abdominal pain.

6.  Hereditary pancreatitis is a rare condition associated with
mutation of cationic trypsin gene.
 They suffer from c/c pancreatitis from teenage and by 8th decade
have high chance of developing Ca.

7. Clinical presentation
 Pain is cardinal symptom
 Develops quickly and reaches peak within minutes to hours and
then plateaus at that level for hours to days
 Pain is constant, refractory to analgesics
 Radiates to the back
 Mimics Perforation, angina or biliary colic
 Nausea and repeated vomiting with retching may be present.
 Hiccoughs d/t distended Stomach  irritation of diaphragm.

8. Signs
 General???
 Abdominal???
 Cullen’s sign
 Grey Turner’s sign

9. Investigation:
 Blood ???
 Imaging ???

10. Imaging:
 X-ray abdomen: Non specific signs like Colon Cut off sign,
renal halo.
 Occasionally calcified gall stones or pancreatic calcification may
be seen
 CXR: Pleural effusion.
 In severe cases diffuse alveolar interstitial shadowing d/t ARDS
 USG: Not quiet useful but can establish Gall stones as the cause
of pancreatitis

11. Assessment of severity:
 Outcome of the patient depends on the severity of the
condition
 Hence assessment of severity is paramount

14.  CT: Not necessary if only a mild attack
 CT advised when
 Diagnostic uncertainty
 Severe acute pancreatitis to diff from interstitial and necrotizing
pancreatitis
 Patients with MODS and progressive sepsis
 Localized complication is suspected

17.  MRI
 EUS and MRCP

18. Management
 Acute Mild Pancreatitis:
 Conservative with IV Fluids and non-invasive monitoring and NG
aspiration + NPO
 Abx not indicated
 Good analgesia.

19.  A/c Severe Pancreatitis Management:
 ICU admission
 Analgesia
 Aggressive fluid management
 Invasive monitoring with Arterial line and CVP, urine output and ABG
 Bloods for hematological and biochemical parameters

20.  Abx prophylaxis. (3rd gen cephalosporins or carbapenem)
 CT scan if organ failure ensues or if clinical deterioration noted
 ERCP if gall stone related pancreatitis to be done within 72 hrs
 Supportive care
 BP Fall ???
 Raised creatinine???
 Respiratory distress ???

21. Systemic Complication
 Cardiovascular : ???
 Pulmonary: ???
 Renal: ???
 Hematological: ???
 Metabolic: ???
 Gastrointestinal: ???

22. Local Complications:
 Acute Fluid collection: Occurs early in severe cases. Usually no
intervention needed.
 If large, guided drainage.
 Sterile and infected pancreatic necrosis:
 CT to find out extent of necrosis
 If sterile  No local intervention
 If Infected  CT guided percutaneous drainage
 Pancreatic necrosectomy
 Retroperitoneal approach

23.  If necrotic material reaccumulates
 Closed continuous lavage
 Closed drainage
 Open packing
 Closure and relaparotomy

24.  Pancreatic abscess:
 Any collection  d/t Pseudocyst or acute pancreatic collection
 Percutaneous drainage  Pus sent for C&S
 Pancreatic ascites:
 Generalized, peritoneal, enzyme rich fluid caused d/t disruption of
pancreatic duct.
 Paracentesis  amylase rich turbid fluid
 Decrease pancreatic secretion by ???

25.  Pancreatic effusion
 Hemorrhage: Pseudo-aneurysm
 Portal and splenic vein thrombosis
 Sudden rise in platelet should rise suspicion.
 Should be screened for pro coagulant status
 For elevated platelets  Anti platelets should be started.

26. Pseudocyst of Pancreas
 Amylase rich fluid collected in wall of fibrous or granulation
tissue.
 Formation requires about 4 weeks.
 Usually forms as a result of a/c pancreatitis.
 Not unusual to have a communication with the pancreatic
duct.
 Diagnosis???
 Treatment???

27. Thank You